[LO 190] MAY 2019 Sub. Code: 2099
M.D. DEGREE EXAMINATION
BRANCH XXI IMMUNOHAEMATOLOGY AND BLOOD TRANSFUSION
PAPER IV RECENT ADVANCES IN IMMUNO-HAEMATOLOGY AND
BLOOD TRANSFUSION
Q.P. Code: 202099
Time: Three Hours Maximum: 100 Marks
I. Essay Questions: x 15 30)
1. Emerging Transfusion transmissible infections and strategies to combat
them in a resource constrained region. Contrast with strategies in other high
income countries.
2. Recent advances in the management of Trauma related blood loss.
II. Short notes: (10 x 5 50)
1. Recombinant erythropoietin in patients with chronic renal failure.
2. Gene editing and its potential for therapeutics.
3. ISBT128 standard in blood banking automation.
4. Factor:VIIa in the management of severe haemorrhage.
5. Platelets for off-label uses.
6. Umbilical cord banking.
7. Restrictive blood transfusion strategy good or bad.
8. Immunotherapy.
9. Rationale of irradiation in the blood bank, platforms available and quality
assurance of irradiated blood components.
10. Stem cells and its application in the blood bank.

III. Reasoning Out: x 5 20)
1. A 10 year old male child with a history of bleeding into joints and deep
haematomas since early childhood is evaluated. He is the first child of a first
degree consanguineous marriage. A maternal uncle had a surgical procedure
where unexpectedly, many units of blood had to be transfused. His blood
tests show: Hb 8.0 TWBC 9,200/cu mm; Plt count 2,32,000/cu
mm. APTT 102 secs (Ref interval 36-42 secs) PT 12.4 secs (Ref interval
11 15 secs), TT 13 secs (Ref interval 12 14 secs).
What is your clinical impression?
What additional tests would you perform to confirm the diagnosis?
What are the risks of transfusion of plasma for this child and how would
you overcome it?
2. You have evaluated a young child with suspected Glanzmann thrombasthenia
Which agonists will you recommend for this child?
Draw the platelet aggregometry curves you will see during the evaluation.
What is the confirmatory test?
3. Blood was taken to the bedside for intended transfusion. When it was
checked, it was found that was a mismatch of the patient ID between the
patient wrist band and on the compatibility report. The doctor has called for
advice.
What type of an event is this in Haemovigilance terminology?
What are the possible reasons such a situation has happened and how can
this be overcome?
What will you advice the doctor?
4. A 48 year old adult from West Bengal came to blood bank to donate
platelets on apheresis. His screening tests showed Hb 14.8 TWBC
7,600/cu mm; Plt count 1,40,000/cu mm with MPV =12.4fl.
What is your possible clinical impression?
What queries will you ask to confirm?
How will you proceed?

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